With 10 years median follow up, the MA.20 trial did not show an overall survival benefit with the additional of regional nodal irradiation compared to breast only radiation. However, subset analyses suggested an overall survival benefit in triple negative disease, which has a shorter time horizon for recurrence. Given the very long time horizon for recurrence of ER+ patients, do we simply need more follow up before we can determine if regional nodal irradiation in ER+, MA.20-like patients improves survival?
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